Chandler and Noah shoot hoops. Noah recently went on a school trip to Washington, D.C., without worrying or needing to call back home.

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Originally published on May 27, 2014 1:35 pm

Children are increasingly anxious, stressed out and overly worried. Part of that has to do with increased pressures to excel in school, sports and extracurricular activities. But part of it has a lot to do with parents.

Like other mental and physical health problems, anxiety can be inherited. And some children are more vulnerable because of the way their anxious parents "parent."

Children whose parents struggle with anxiety are 2- to 7-times more likely to develop an anxiety disorder themselves, according to Golda Ginsburg, a psychologist at the Johns Hopkins University School of Medicine who studies childhood anxiety.

That's partly a result of how parents view the world. If they see it as a scary place, their children often do as well. Parents are a child's role model for many behaviors, including anxiety, says Ginsburg. "So if a parent is showing anxiety, jumping up on a table when they see a mouse versus reacting calmly, we know children are more likely to develop fears similar to what their parents are showing."

Take the example of Heather Cummings and her son Noah. It was difficult for Noah to go to elementary school. He was constantly worried that he would get sick and throw up, particularly at school.

It turns out that Heather suffered similar worries when she was a child. "In science I'd read about a condition and think I had it, cancer or diabetes, for example," she says. "If I bumped my head I'd think I'd get a concussion. If I got hit in the temple I'd watch the clock because I thought I was going to die."

Anxiety is a normal human emotion in the face of challenges, such as taking a test or performing in public. But in more severe forms it can be debilitating. Anxiety that interferes with normal life activities like school, work or social relationships can be an indication of a severe anxiety disorder.

When Noah was a toddler, if he disappeared behind a tree Heather worried that he had been kidnapped. "I was panic-stricken." As Noah got older Heather's anxiety shifted, and she worried more about his anxiety. Both Heather and her husband, Dave, who live in Epsom, N.H., found themselves constantly reassuring Noah that he was fine, that he wouldn't throw up and that everything would be OK.

They got the school to agree to allow Noah to call home when he got worried. He did, five or six times a day. Dave even once spent an entire day in the classroom. He says, "I just went there to be sitting in the classroom with him; my entire focus was on Noah, on how he was doing. I'd give him a reassuring smile, rub his back, anything in my power to reassure him that things are going to be OK."

But all this reassurance and effort turned out to be exhausting for everyone.

By the time Noah was 11, the family was so overwhelmed that they knew they had to do something. They had heard an expert in anxiety speak at a parent meeting and they decided to go see her. By the time they arrived at the office of psychotherapist Lynn Lyons in nearby Concord, Noah's anxiety was severe, Lyons says.

The first step for Noah was to help him understand how anxiety made his stomach ache. Lyons often draws cartoons to show children how their bodies react to anxiety, with an increase in stress hormones accompanied by a racing heart, faster breathing, tense muscles and a churning stomach. Noah got the message.

The biggest surprise, though, was for Heather and Dave. Lyons told them that all their efforts to help Noah avoid his anxiety were actually fueling it.

"The way you learn how to manage life is by making mistakes or by stepping into things that feel uncertain, uncomfortable, or overwhelming and then proving to yourself through experience that you can manage it," Lyons says. The Cummingses were inadvertently suggesting to Noah that he couldn't handle it.

Noah had to learn how to face his fears, and his parents had to help him. This meant no more reassurance. It wasn't easy, but both Heather and Dave were committed to change. So was Noah.

Lyons used a technique called cognitive behavioral therapy that helps people learn how to change negative thoughts about specific experiences. This therapy has been shown effective in treating anxiety disorders, but can be useful as well for anyone dealing with stressful life situations.

Noah had to limit phoning or texting home from school to twice a week, then once a week, then every other week and so on, until he stopped altogether.

As for throwing up in school, Noah had to accept that he might. "So rather than avoiding it, he had to start saying, 'Hey, if I get sick, I get sick. I won't like it, but I'll survive,' " Lyons says.

When Lyons told Noah to think about the worst that could happen, he realized that going to the nurse's office and being sent home just wasn't all that bad. He never did throw up in school. And today, two years after therapy started, he no longer worries about it.

His parents now know what to say when he does get worried. That includes labeling the worry as worry, and asking, "What's the worst that could happen?"

In short, the therapy worked, for parents and child.

About a month ago Noah, now 13, went on a five-day school trip to Washington, D.C.

"As it got closer and closer, I got more and more excited rather than worried," Noah says. "When I got onto the bus to go I was not worried at all! I didn't have one worry about going on the trip."

And rather than being inundated with calls or texts, Noah's parents didn't hear a thing. "On this trip we would have liked a couple more calls," Dave Cummings says. "It's ironic that he didn't call at all; it's the greatest victory possible."

Lyons says it really doesn't matter what's provoking a child's anxiety — it could be school, or getting up at bat, performing in a play or singing a song in public. The key, she says, is helping children expect it and have a plan on how to deal with it. Then they can move on, stronger and more capable of coping with life's uncertainties. (Lyons recently co-authored a book entitled Anxious Kids Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous & Independent Children.)

Cognitive behavioral therapy may also help prevent anxiety from developing in the first place, Ginsburg says. She has studied vulnerable children who had at least one anxious parent. In her study, half of the children ages 7 to 12 and their parents received cognitive behavioral therapy. Half did not.

It turned out that one-third of those who did not receive therapy developed an anxiety disorder within a year. None of those who received therapy developed anxiety.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

DAVID GREENE, HOST:

This is MORNING EDITION from NPR News. I'm David Greene.

STEVE INSKEEP, HOST:

And I'm Steve Inskeep. Good morning. Today in Your Health, anxiety and parenting. If you're an anxious person, chances are you are passing your worries on to your child or children. And if a child's anxiety becomes severe, it could put the child at risk for developing depression in later years. But as NPR's Patti Neighmond reports, there are very concrete and practical steps parents and kids can take.

PATTI NEIGHMOND, BYLINE: It's early on a Tuesday morning, and Heather and Dave Cummings are getting their three children ready for school - packing lunch, eating breakfast - before the bus arrives.

HEATHER CUMMINGS: All right, so dad will get you from practice. Have a good day.

NOAH CUMMINGS: Yep. You, too.

NEIGHMOND: A typical sendoff. But for 13-year-old Noah Cummings - two years ago when he was 11, things were completely different.

N. CUMMINGS: I would be scared everywhere I went that I was going to throw up.

NEIGHMOND: Especially at school. Noah was often sent home because he felt sick. For him, normal childhood worries had become debilitating.

N. CUMMINGS: I worried about having cancer, having tumors. I worried about passing out.

NEIGHMOND: Now, it turns out Noah's mom, Heather Cummings, also suffered severe anxiety when she was Noah's age.

H. CUMMINGS: You know, I'd bump my head and think I was going to have a, you know, concussion or get hit close to my temple and clearly, you know, watch the clock 'cause I'm going to die.

NEIGHMOND: Researchers say it's pretty common for parents to pass anxiety like this on to their kids. Some of it's genetics like other mental or physical conditions. But some of it's the way anxious parents parent. Golda Ginsberg is a psychologist at Johns Hopkins University. She says studies show how much children of anxious parents are at risk.

GOLDA GINSBERG: We know that children whose parents struggle with anxiety are somewhere between two and seven times more likely to develop an anxiety disorder themselves.

NEIGHMOND: It's partly how a parent views the world. If they see it as a scary place, often their children do, too.

GINSBERG: We know that children will model their parents. So if a parent is showing anxiety - jumping up on the table if they see a mouse - versus, you know, reacting calmly, we know that children are going to - certainly anxious children are more likely to develop fears that are similar to what their parents are showing.

NEIGHMOND: This is exactly what happened to Heather Cummings and her son Noah. When he was a toddler, if he disappeared behind a tree, she thought he'd been kidnapped. As he got older, her anxiety shifted and she worried more about his anxiety.

H. CUMMINGS: You just think if you love them a little more or you reassure them enough, eventually one day they'll wake up and not be worried anymore because you're saying all the right things and you're doing all the right things.

NEIGHMOND: Sadly, all the right things were in fact making Noah's anxiety worse. His parents constantly reassured him that he was fine. They asked the school to allow Noah to call home when he got worried. He did about five or six times a day. His father, Dave Cummings, even spent an entire day in the classroom.

DAVE CUMMINGS: I went in just to be sitting there in the classroom with him, and my entire focus is just on Noah - how is he handling each moment, how is he doing - and just giving him a reassuring smile or going over and rubbing his back or just, you know, for a second - just doing anything in my power to reassure him that things are going to be OK.

NEIGHMOND: But finally, the family was so overwhelmed they knew they had to do something. By the time they arrived at the office of psychotherapist Lynn Lyons, Noah's anxiety was severe. Lyons specializes in anxiety. And the first step for Noah, she says, was to understand how his anxiety was affecting his body.

LYNN LYONS: Your worry grabs onto your imagination and then it sets off that part of your brain called the amygdala. That's your alarm system.

NEIGHMOND: Which signals the brain to produce more adrenaline. The heart pounds, blood rushes, breathing becomes heavy, muscles tense and the stomach churns.

LYONS: And all of these reactions are really automatic and really primitive. So now your body is ready for an attack by a saber tooth tiger, and actually you just have to take a spelling test.

NEIGHMOND: And the big surprise for Heather and Dave Cummings was that all their reassurances were actually fueling Noah's anxiety.

LYONS: The way that you learn how to manage life is by making mistakes or by stepping into things that feel uncertain, that feel uncomfortable, that feel overwhelming and then proving to yourself through experience that you can manage it.

NEIGHMOND: So what Noah had to do was stop his body's automatic response.

LYONS: When Noah's worry talked, Noah listened.

NEIGHMOND: Lyons uses cognitive behavior therapy - CBT - to help kids like Noah do a 180 and completely turn around the way they perceive anxiety.

LYONS: So he had to start to talk back to it. He had to start to do the things that his worry said he couldn't do.

NEIGHMOND: If Noah's worry told him he couldn't handle school, then Lyons says he had to confront it and say, yes, I can.

LYONS: So some of the assignments were that he couldn't call or text is mom. You know, he'd get on the bus and he wanted to text his mom when he was on the bus. He wanted to text his mom when he got off the bus. He wanted to text his mom when he was at school.

NEIGHMOND: At first, the goal was to text or phone home no more than twice a week, then once a week, then once every other week and so on until Noah was no longer phoning or texting home at all. But what about his biggest fear - throwing up in school? What if it really happened? Lyons offered a technique to cope with that.

N. CUMMINGS: She would have me tell her what's everything that happens if you throw up? What's the worst thing? I would say, I throw up. I go to the nurse's office. She sends me home. Then I would say to myself wait, why do I worry about this all the time if that's the worst thing that can happen?

LYONS: So rather than avoiding, we had to start saying, hey, if I get sick, I get sick. I won't like it, but I'll survive it. And that was a big deal for him.

NEIGHMOND: At Johns Hopkins University, psychologist Golda Ginsburg says research shows this type of therapy works well to help kids like Noah work through their anxiety. But Ginsburg wanted to know if it could also help prevent anxiety in the first place. In her study, half of the children aged 7 to 12 and their parents received therapy. The other half did not.

GINSBERG: In the kids who just got monitored, 30 percent developed a disorder by the end of the one year. And when we looked at those who were in the intervention group, none of those kids developed a disorder at the one-year mark.

NEIGHMOND: And the therapy isn't just for kids. Parents also need to change. For Heather and Dave Cummings, they had to stop reassuring Noah that everything would be OK.

H. CUMMINGS: I think the hardest thing for me, and I think for Dave as well, was when Noah would, you know, come to us in the morning before school and say, do I look OK, am I going to be OK, will I be sick, and we couldn't answer him.

NEIGHMOND: Today, two years after the Cummings started therapy, their lives have in fact turned around. Tonight's dinner's a little like breakfast. It's one of the kid's favorites - sizzling bacon and French toast. Heather, Dave and Noah say they all feel pretty normal these days, and they're greatly relieved. And recently there was a huge success. About a month ago, Noah went on a five-day school trip to Washington, D.C., and he wasn't worried.

N. CUMMINGS: As we got closer and closer, I just got more and more excited about it rather than worried about it. And when I got on the bus to go, I was not worried at all about it. I didn't have one worry about going on the trip.

NEIGHMOND: And the number of phone calls? It speaks for itself.

D. CUMMINGS: On this trip we would've liked a couple more calls. And it was - it's ironic that, you know, he didn't call at all. And it was the greatest sort of victory possible.

NEIGHMOND: Therapist Lynn Lyons says it really doesn't matter what's provoking a child's anxiety. It could be school or getting up to bat, performing in a play or singing a song in public. The key, she says, is to help your kids expect it and have a plan on how to deal with it. Then they can move on stronger and more capable of coping with life's uncertainties. Patti Neighmond, NPR News.